In the world of manufacturing, the term “six sigma” refers to the ability to produce items that are 99.9996% free from defects. As we step into the next levels of healthcare technology, the desire for six sigma in healthcare will increase. Is that realistic?

What would six sigma look like in healthcare? Surgeries would be successful, with only a few exceptions; diseases would be cured, except for a very few people; equipment would function with almost no failure; professionals would make very few mistakes. We would have working models of treatment for complex medical conditions, and these models would be successful. What stops us from achieving these goals?

One factor is the unpredictability of both medical conditions and human beings. While, from a technical standpoint, we could produce equipment and technology that reaches six sigma, people do not function in the same way, and by “people” I mean providers as well as the people they care for. If three people are diagnosed with a leukemia, factors such as age, access to healthcare, insurance coverage, available economic resources, geographic area of the country, family dynamics, religious and spiritual values—all will affect their decisions about the course of treatment they wish. Providers are affected by training, experience, ability to work with diverse populations, persistence, curiosity, and compassion. Providers have good days and bad days, just like everyone. Is every day a “six sigma” day without mistakes? No. Is every day a “six sigma” day for people trying to decide about their healthcare? Also no.

So we are left in a medical world with imperfect people, complex decisions and limited resources. What, then, becomes important in healthcare?

That we use technology in the best ways we can to increase the likelihood of six sigma outcomes. A good example is the bar coding that is appearing on medications in hospital: those codes are matched to the patient’s wristband so the likelihood of the wrong medication being given to a patient is greatly reduced. Or drug interaction applications for the smart phones: for every client I work with, I check their medications in Epocrates, a program on my phone that will alert me to possible interactions. It’s my signal to consult with a pharmacist and the physician to double check, especially when many different physicians are writing prescriptions for my client. You can do this kind of check yourself.

That we realize that people’s decisions about their healthcare will not fall into “six sigma” thinking. Many subjective factors—quality of life being one of them—drive people’s decisions about what treatments they want. My job as a healthcare advocate is to help people create the decisions that work for them, based on their personal beliefs and goals.

That we accept that our capacity to create solutions in healthcare does not mean those solutions are appropriate for everyone. Value-based decision-making in healthcare will play an increasingly important role in how and what care is provided.

Six Sigma may not be possible, but attentive, effective healthcare is.